Provider Demographics
NPI:1598961492
Name:FERNANDES, JENNIFER (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 WHITE OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-1230
Mailing Address - Country:US
Mailing Address - Phone:973-258-0930
Mailing Address - Fax:
Practice Address - Street 1:372 WHITE OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-1230
Practice Address - Country:US
Practice Address - Phone:973-258-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTO002612225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist